Dispensing (201-300 questions)

b. decreases oral hypoglycemic effect

---

The interaction between glibenclamide (a sulfonylurea oral hypoglycemic) and thiazide diuretics can reduce the hypoglycemic effect of glibenclamide.

Glibenclamide-thiazide diuretics interaction may result to;

a. increase potassium level

b. decreases oral hypoglycemic effect

c. platelet inhibition

d. sodium depletion

b. hyperkalemia

---

Enalapril (an ACE inhibitor) and spironolactone (a potassium-sparing diuretic) both increase potassium levels by reducing its excretion in the kidneys.

Concurrent administration of Enalapril and Spironolactone should be used with caution because of the risk of;

a. hypokalemia

b. hyperkalemia

c. dehydration

d. excessive CNS depression

b. beneficial synergistic combination

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Sulfathiazole (a sulfonamide) and trimethoprim inhibit sequential steps in bacterial folate synthesis:

• Sulfonamides block dihydropteroate synthase

• Trimethoprim blocks dihydrofolate reductase

When used together, they produce a synergistic antibacterial effect that is beneficial, because the combination is more effective than either drug alone and reduces the risk of resistance

Sulfathiazole and Trimethoprim is a;

a. harmful antagonistic combination

b. beneficial synergistic combination

c. beneficial antagonistic combination

d. harmful synergistic combination

a. Displacement of warfarin from its protein binding sites by sulfonamides may lead to thrombosis.

---

Reason: displacement of warfarin from protein-binding sites increases the free (active) warfarin concentration, which raises bleeding risk, not thrombosis. The other statements (b, c, d) are correct.

Which of the following statements is NOT correct?

a. Displacement of warfarin from its protein binding sites by sulfonamides may lead to thrombosis.

b. Antibiotics, by reducing the GI flora, may interrupt the enterohepatic recirculation of oral contraceptives resulting to reduction in the serum estrogen concentrations.

c. Probenecid decreases renal excretion of penicillin by blocking the active tubular secretion of the antibacterial drug.

d. Phenobarbital, antihistamine, and alcohol have additive sedative activity.

d. protein-rich food

The bioavailability of propranolol is increased if taken with;

a. coffee

b. carbohydrate-rich food

c. high-fat content meal

d. protein-rich food

c. I and III

TRUE statements regarding the effect of food/diet include;

I. Calcium ion in dairy products chelates tetracycline thus decreasing its absorption

II. Felodipine (Plendil) - plasma level is decreased by grapefruit juice

III. Plasma concentration of cetirizine and loratidine are decreased by fruit juices

a. I, II and III

b. II and III

c. I and III

d. I and II

b. hypokalemia

---

Aloe vera (especially when taken orally as a laxative) can cause potassium loss through increased bowel movements.

Thiazide diuretics also cause potassium loss via the kidneys.

When combined, the risk of hypokalemia (low potassium) is increased.

Aloe vera-thiazide diuretics interaction may result to;

a. increase potassium level

b. hypokalemia

c. platelet inhibition

d. sodium depletion

b. Hyperglycemia

Too rapid infusion of TPN may lead to this complication.

a. Sepsis

b. Hyperglycemia

c. Anemia

d. Hyperammonemia

a. I, II and III

Which of the following statements characterize an adverse drug reaction (ADR)?

I. a reaction that is noxious and unintended

II. may occur at doses normally used for prophylaxis, diagnosis, or therapy of disease

III. side effects and allergy are ADR

a. I, II and III

b. I and II

c. I and III

d. II and III

a. adverse drug event

Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer is termed as;

a. adverse drug event

b. medication error

c. side effect

d. anaphylaxis

c. side effect

An expected and known effect of a drug that is not the intended therapeutic outcome is termed as;

a. allergy

b. idiosyncratic reaction

c. side effect

d. hypersensitivity reaction

a. I, II and III

Patients who are more likely to experience ADR include;

I. Elderly

II. Obese and malnourished

III. With chronic disease

a. I, II and III

b. I and II

c. I and III

d. II and III

c. Taking multiple prescription medicines, OTC drugs and alternative products increase the risk of experiencing an ADR.

---

a. ❌ False — Elderly are more predisposed to drug toxicity due to reduced renal/hepatic function, polypharmacy, and altered pharmacokinetics.

b. ❌ False — Females often have an equal or higher risk of ADRs than males, partly due to differences in metabolism, hormones, and body composition.

c. ✅ True — Taking multiple prescription medicines, OTC drugs, and alternative products increases the risk of ADR because of polypharmacy and possible drug–drug or drug–herb interactions.

d. ❌ False — ADRs from aminoglycosides, digoxin, and theophylline are mainly related to dose and serum levels, not primarily to genetic factors.

Which of the following statements is TRUE regarding risk factors of ADR?

a. Young adults are predisposed more to drug toxicity than elderly.

b. Female have lesser risk of developing ADR than male.

c. Taking multiple prescription medicines, OTC drugs and alternative products increase the risk of experiencing an ADR.

d. Aminoglycosides, digoxin, and theophylline ADR are attributed to genetic factors.

b. subacute

ADR may be classified according to their onset or timing of reaction. Which of these is occurring within 24 hours of drug exposure?

a. acute

b. subacute

c. latent

d. mild

b. moderate

---

• Mild → No treatment needed, symptoms are self-limiting.

• Moderate → Requires active treatment of the adverse reaction, or further testing/evaluation to assess it. ✅

• Severe → Life-threatening, requires intensive medical intervention, or results in disability/death.

ADR may also be classified according to their severity. What class requires active treatment of adverse reaction, or further testing or evaluation to assess?

a. mild

b. moderate

c. severe

d. significant

c. within 2 or more days of exposure

A latent ADR appears;

a. within 1 hour of exposure

b. with 1 week of exposure

c. within 2 or more days of exposure

d. within 2 or more weeks of exposure

d. I, II and III

FDA defines significant ADRs as those that are;

I. Life-threatening

II. Permanently or significantly disabling

III. Require or substantially prolong hospitalization

a. I and III

b. II and III

c. I and II

d. I, II and III

b. II and III

Type F ADR or failure of therapy may be due to;

I. patient compliance

II. antimicrobial resistance

III. drug interactions

a. I, II and III

b. II and III

c. I and II

d. I and III

c. I and II

Type B ADR can be described as;

I. unrelated to the drug's pharmacological effect dependent

II. not dose dependent

III. common, predictable and less serious than Type A

a. I, II and III

b. II and III

c. I and II

d. I and III

b. III only

Idiosyncratic reactions are considered;

I. Type A

II. predictable

III. non-immunologic

a. I only

b. III only

c. I and II

d. I and III

d. Type D

Carcinogenicity is under what type of ADR?

a. Type A

b. Type B

c. Type C

d. Type D

d. Type A

---

Extensive sedation from decreased clearance of a usual benzodiazepine dose is:

• Predictable (linked to drug’s known pharmacology)

• Dose-related (higher blood levels due to reduced clearance)

That makes it a Type A ADR.

Correct answer: d. Type A ✅

Extensive sedation caused by decreased clearance of a usual dose of a benzodiazepine is an example of:

a. Type E

b. Type F

c. Type B

d. Type A

a. Type I

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Anaphylaxis from a beta-lactam antibiotic is an immediate hypersensitivity reaction mediated by IgE antibodies — this is Type I hypersensitivity.

Correct answer: a. Type I ✅

Anaphylaxis from a beta-lactam antibiotics is an immunologic reaction classed as:

a. Type I

b. Type II

c. Type III

d. Type IV

a. Doxurubicin

---

Cardiotoxicity as a delayed ADR is classically associated with doxorubicin (and other anthracyclines).

Cardiotoxicity is a delayed ADR associated with which chemotherapeutic agent?

a. Doxurubicin

b. Paclitaxel

c. Vincristine

d. Cisplatin

a. I and II

---

Chloramphenicol is associated with:

• I. Aplastic anemia ✅ (rare, irreversible, and can be fatal)

• II. Gray baby syndrome ✅ (due to immature liver metabolism in newborns)

• III. SLE-like syndrome ❌ (that’s linked to drugs like hydralazine, procainamide, isoniazid)

Untoward reaction linked to Chloramphenicol include:

I. Aplastic anemia

II. Gray baby syndrome

III. SLE-like syndrome

a. I and II

b. I and III

c. II and III

d. I, II, and III

c. erythema multiforme

---

The description — large, deep red skin lesions with darker centers after a few days on a beta-lactam antibiotic — is characteristic of erythema multiforme.

• Erythema multiforme: Target-like (“bull’s-eye”) lesions, often drug-induced or triggered by infections.

• Toxic epidermal necrolysis: Widespread skin detachment and mucosal involvement, much more severe.

• Photosensitivity: Rash on sun-exposed areas.

• Serum sickness: Fever, rash, arthralgia, and lymphadenopathy.

Mrs. K experienced skin rash, which are large, deep red and look darker at the center after taking a beta-lactam antibiotic for 3 days. The ADR is suspected to be;

a. photosensitivity reaction

b. toxic epidermal necrolysis

c. erythema multiforme

d. serum sickness

c. Increase in BP

---

Phenylpropanolamine is a sympathomimetic that can cause vasoconstriction, leading to increased blood pressure.

The adverse effect that may be produced by cough and cold remedies containing phenylpropanolamine is;

a. GI disturbances

b. Serum sickness

c. Increase in BP

d. Decrease in BP

b. thalidomide

---

• Phocomelia → Thalidomide

• Craniofacial/CNS defects → Tretinoin

• Fetal hydantoin syndrome → Phenytoin

• Various possible anomalies → Phenothiazines

Phocomelia is a teratogenic effect associated with the use of;

a. tretinoin

b. thalidomide

c. phenytoin

d. phenothiazines

d. II and III

NSAID's induced ADR include;

I. cardiotoxicity

II. nephropathy

III. GI ulcer

a. I, II and III

b. I and II

c. I and III

d. II and III

c. II and III

Ototoxicity or hearing loss is an ADR commonly associated with the use of;

I. Phenothiazines

II. Loop agents

III. Aminoglycosides

a. I, II, and III

b. I and III

c. II and III

d. I and II

a. Statins

---

Severe myopathy and rhabdomyolysis are well-known adverse effects of statins (HMG-CoA reductase inhibitors), especially at high doses or when combined with certain interacting drugs.

Severe myopathy and rhabdomyolysis can be induced by which group of agents?

a. Statins

b. NSAIDs

c. Sulfonylureas

d. Beta-blockers

d. II and III

A drug-induced hypersensitivity reaction caused by sulfonamides:

I. Parkinson's disease

II. Steven-Johnson's disease

III. Contact dermatitis

a. I, II, and III

b. I and II

c. I and II

d. II and III

b. Malignant hyperthermia from antipsychotic

---

The idiosyncratic reaction is a rare, unpredictable response not related to the drug’s known pharmacology.

Let’s analyze:

• a. Anaphylaxis from penicillin → Immunologic, but predictable in allergic individuals, not idiosyncratic.

• b. Malignant hyperthermia from antipsychotic → This is actually triggered by certain anesthetics and some antipsychotics (neuroleptic malignant syndrome) can cause a similar severe reaction, which is considered idiosyncratic because it’s unpredictable and linked to genetic susceptibility.

• c. Flushing and hypotension from Vancomycin → Known “red man syndrome,” a predictable infusion-related reaction.

• d. Hypoglycemia from oral sulfonylureas → Predictable, dose-related pharmacologic effect.

Correct answer: b. Malignant hyperthermia (or neuroleptic malignant syndrome) from antipsychotic ✅

Which of the following is an idiosyncratic reaction?

a. Anaphylaxis from penicillin

b. Malignant hyperthermia from antipsychotic

c. Flushing and hypotension from Vancomycin

d. Hypoglycemia from oral sulfonylureas

a. Isoniazid

---

• Isoniazid: = peripheral neuritis (nerve damage), especially in slow acetylators.

• Ethambutol: = optic neuritis (vision problems)

• Pyrazinamide: = liver toxicity and gout

• Rifampin: = liver toxicity and orange body fluids

Which of the following anti-TB drugs will cause peripheral neuritis in slow acetylators?

a. Isoniazid

b. Ethambutol

c. PZA

d. Rifampin

d. aspirin

This analgesic-antipyretic drug should not be used in children with chickenpox or flu.

a. Paracetamol

b. ibuprofen

c. Mefenamic acid

d. aspirin

c. aspirin

---

Reye's syndrome is a rare but serious condition causing swelling in the liver and brain, mostly seen in children and teenagers recovering from viral infections.

It has been strongly linked to the use of aspirin during viral illnesses.

Reye's syndrome has been associated with the use of which analgesic drug?

a. naproxen

b. celecoxib

c. aspirin

d. paracetamol

a. Stevens-Johnson syndrome

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SJS is immunologic

Non-immunologic drug reactions include all of the following EXCEPT;

a. Stevens-Johnson syndrome

b. Dry mouth from antihistamines

c. Thrush while taking antibiotics

d. Hepatotoxicity from methotrexate

c. immune complex

---

• Type I : Immediate, IgE-mediated allergy

• Type II: Cytotoxic (antibody destroys cells)

• Type III: Immune complex (antigen-antibody complexes cause inflammation)

• Type IV: Delayed cell-mediated (T-cell response, delayed)

• Idiosyncratic: Unpredictable, non-immune reactions unique to the individual

Type III immunologic drug reactions is described as;

a. cytotoxic

b. idiosyncratic

c. immune complex

d. delayed cell mediated

d. allergic contact dermatitis

---

• Type I: Urticaria (immediate, IgE-mediated)

• Type II: Thrombocytopenia (cytotoxic antibody-mediated)

• Type III: Serum sickness (immune complex-mediated)

• Type IV: Allergic contact dermatitis (delayed, T-cell mediated)

An example of Type IV hypersensitivity reactions;

a. urticaria

b. thrombocytopenia

c. serum sickness

d. allergic contact dermatitis

b. hydralazine

Lupus-like syndrome is associated with which agent?

a. sulfonamides

b. hydralazine

c. anticonvulsants

d. carbamazepine

d. idiosyncratic reaction

Development of anemia with the use of anti-oxidant drugs in the presence of glucose-6 phosphate dehydrogenase deficiency is an example of;

a. intolerance

b. hypersensitivity

c. pseudo-allergic reaction

d. idiosyncratic reaction

d. hemolytic anemia

---

Clinical manifestations of IgE-mediated (Type I) immune reactions include:

• a. Urticaria → Yes

• b. Bronchospasm → Yes

• c. Anaphylaxis → Yes

• d. Hemolytic anemia → No (this is a Type II, cytotoxic antibody reaction)

Clinical manifestations of Ig-E type immune drug reactions include all of the following EXCEPT;

a. Urticaria

b. bronchospasm

c. anaphylaxis

d. hemolytic anemia

d. II and III

Which of the following statements is CORRECT regarding conjunctival pigmentation as an ADR?

I. Phenytoin can cause this effect

II. It is the grayish-brown discoloration of the conjunctiva

III. It is dose related

a. I and II

b. I and II

c. I and III

d. II and III

d. I, II and III

ADR associated with the use of phenytoin include;

I. gingival hyperplasia

II. Steven's Johnson Syndrome

III. hirsutism

a. I and II

b. I and III

c. II and III

d. I, II and III

b. busulfan

This agent can cause pulmonary toxicity.

a. penicillin

b. busulfan

c. diethylstilbestrol

d. aspirin

b. exaggerated sun-burn like reactions

---

• a. bright or dark red macules → could describe other rashes but not classic phototoxicity

• c. malaise and fever = systemic symptoms, not specific to phototoxicity

• d. erosions and hemorrhagic crusting... → describes Stevens-Johnson syndrome

Phototoxic reactions are manifested as;

a. bright or dark red macules

b. exaggerated sun-burn like reactions

c. malaise and fever

d. erosions and hemorrhagic crusting of the lips, oral mucosa, conjunctiva, urethra and anogenital regions

c. Serum sickness

---

Serum sickness is a delayed allergic reaction caused by the immune system reacting to foreign proteins or haptens in the blood stream

• Anaphylactic reaction is an immediate, severe allergic reaction.

• Pseudo-allergic reactions mimic allergies but don’t involve the immune system.

• Lupus-like syndrome is an autoimmune condition, not related to foreign proteins entering the bloodstream.

A delayed allergic response by the immune system against a large amount of foreign protein or hapten that have entered the bloodstream.

a. Anaphylactic reaction

b. Pseudo-allergic reactions

c. Serum sickness

d. Lupus-like syndrome

d. Tardive dyskinesia from antipsychotics

Type C ADR include all of the following EXCEPT;

a. Adrenal suppression due to prolonged corticosteroid administration

b. Drug dependency

c. Analgesic nephropathy

d. Tardive dyskinesia from antipsychotics

b. Type E

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Opiate withdrawal is an adverse drug reaction related to withdrawal or failure after stopping the drug.

This fits Type E ADR (End-of-use or withdrawal reactions).

Opiate withdrawal is an ADR classified as;

a. Type F

b. Type E

c. Type D

d. Type C

c. secondary effect

---

c. secondary effect

• It happens because antibiotics disrupt normal gut flora, leading to side issues like diarrhea, not a direct toxic effect or overdose.

Development of diarrhea with antibiotic therapy due to altered gastrointestinal bacterial flora is an ADR due to;

a. overdose

b. side effect

c. secondary effect

d. drug interaction

b. hepatic failure due to paracetamol

---

• a. Sedation with antihistamines = side effect

• b. hepatic failure due to paracetamol = overdose

• c. Tachycardia from albuterol = side effect due to its stimulant action

• d. Diarrhea from amoxicillin = secondary effect due to alteration of gut flora

Which of the following toxicities (ADR) is due to overdosage?

a. sedation with antihistamines

b. hepatic failure due to paracetamol

c. tachycardia from albuterol

d. diarrhea from amoxicillin

b. intolerance to the dose of salicylate

---

Explanation:
Tinnitus (hearing a sound ) from aspirin at normal or small doses is usually a sign of dose-related intolerance

Following a single, small dose of ASA, a patient experienced ringing on both ears. This reaction could be due to;

a. pharmacologic side effect of ASA

b. intolerance to the dose of salicylate

c. allergic reaction to ASA

d. secondary pharmacologic side effect

c. megaloblastic anemia

A drug-induced reaction associated with folate antagonist is;

a. dermatologic reactions

b. serum sickness

c. megaloblastic anemia

d. cirrhosis

a. ACE inhibitor

• ARBS dapat

A patient with on stage C heart failure complains on dry, and persistent cough. Which of the drugs for HF could be implicated with the patients’ complaint?

a. ACE inhibitor

b. Beta blocker

c. Calcium channel blocker

d. Digoxin

a. I, II and III

Bronchoconstriction may be precipitated by;

I. atenolol

II. aspirin

III. tartrazine

a. I, II and III

b. II and III

c. I and II

d. I only

d. diarrhea

Which of the following is NOT an anticholinergic effect?

a. dry mouth

b. urinary retention

c. tachycardia

d. diarrhea

• Diarrhea

• Constipation

What is the side effect of [2]

• Cholinergic drug= ___ [diarrhea/constipation]?

• Anticholinergic drug = ___ [diarrhea/constipation]?

a. I, II and III

Situations or conditions that may lead to tachycardia include;

I. hypoglycemia

II. large consumption of energy beverages

III. concomitant administration of theophylline and erythromycin

a. I, II and III

b. I and III

c. I and II

d. II only

a. I, II and III

---

The correct answer is:

a. I, II and III

Explanation:

• Prazosin can cause orthostatic hypotension (drop in blood pressure when standing), increasing fall risk.

• Diphenhydramine is an antihistamine with sedative effects, causing drowsiness and impaired coordination.

• Diazepam is a benzodiazepine that causes sedation, muscle relaxation, and impaired balance.

Incidence of falls and injuries are associated with the;

I. Prazosin

II. Diphenhydramine

III. Diazepam

a. I, II and III

b. I and III

c. I and II

d. II only

c. I and II

Orthostatic hypotension is common to;

I. TCA's

II. Phenothiazines

III. alpha-agonists

a. I, II and III

b. I and III

c. I and II

d. III only

b. antipsychotics

Extrapyramidal effect, such as Parkinson-like reaction is commonly associated with which group of drugs?

a. antidepressants

b. antipsychotics

c. neuromuscular blockers

d. all of these

c. COMT inhibitors

Drugs that should NOT be given with levodopa include all of the following EXCEPT;

a. nonselective MAOIs

b. Pyridoxine

c. COMT inhibitors

d. Antipsychotics

d. lithium

Due to sodium depletion, diuretics increase the toxicity of;

a. digoxin

b. antigout drugs

c. oral hypoglycemic

d. lithium

b. Sympathomimetics

---

• MAOIs block the breakdown of monoamines like norepinephrine.

• Taking MAOIs with sympathomimetic drugs (which increase norepinephrine release or mimic its effects) can cause excessive stimulation.

• This leads to hypertensive crisis, severe headache, and cardiac arrhythmias.

Severe headache, hypertensive crisis and cardiac arrhythmias are toxicities than can develop if MAOIs are taken with;

a. TCAs

b. Sympathomimetics

c. NSAIDs

d. Diuretics

c. guanethidine

TCAs can inhibit the uptake of this drug into nerve terminal resulting to reduced antihypertensive action.

a. clonidine

b. prazosin

c. guanethidine

d. captopril

a. worsens ulcer

Ergot alkaloids can;

a. worsens ulcer

b. precipitate gouty arthritis

c. induce hypothyroidism

d. aggravate psychosis

acidic in nature

Ergot alkaloids is ____ [acidic /basic] in nature ?

c. II and III

Atropine-like reactions can be observed in;

I. Benztropine

II. Imipramine

III. Phenelzine

a. I, II and III

b. I and II

c. II and III

d. I and III

b. severe hypotension

---

Explanation:

• Sildenafil (a PDE5 inhibitor) and organic nitrates both cause vasodilation.

• When taken together, their effects add up, leading to a dangerous drop in blood pressure (severe hypotension), which can be life-threatening.

Sildenafil is contraindicated with organic nitrates because the interaction could lead to:

a. hypertensive crisis

b. severe hypotension

c. hypokalemia

d. arrhythmias

c. opiates

---

Opiate overdose causes respiratory depression characteristic pin point pupil (miosis)

Except : Meperidine (mydriasis )

Respiratory depression with a characteristic pin point pupil is associated with overdosage of:

a. barbiturates

b. benzodiazepines

c. opiates

d. alcohol

• miotic

• mydriatic

• Pin point pupil = ___ [miotic/ mydriatic]

• Dilated pupil = ____ [miotic/ mydriatic]

a. androgens

---

Exposure to androgens (male sex hormones) during pregnancy can cause masculinization (development of male characteristics) of a female fetus

Masculinization of the female fetus can result after uterine exposure to;

a. androgens

b. estrogens

c. carbamazepine

d. thalidomide

d. III only

Amphotericin B, a systemic antifungal agent is;

I. ototoxic

II. hepatotoxic

III. nephrotoxic

a. I, II and III

b. I and II

c. I only

d. III only

b. Gasping syndrome

---

• Gasping syndrome = benzyl alcohol

• Gray baby syndrome = chloramphenicol

• Reye’s syndrome = aspirin

• Cushing syndrome = too much cortisol (steroid hormone)

Newborns exposed repeatedly to benzyl alcohol, a preservative in many injectable products, may lead to a potentially fatal condition referred to as;

a. Cushing syndrome

b. Gasping syndrome

c. Gray -baby syndrome

d. Reye’s syndrome

a. Amiodarone

---

• Amiodarone = drug-induced hyperthyroidism

• Verapamil = calcium channel blocker (no hyperthyroidism)

• Quinidine = antiarrhythmic (no hyperthyroidism)

• Propranolol = beta-blocker (used to treat symptoms of hyperthyroidism)

Drug-induced hyperthyroidism could be associated with which of the following drugs for arrhythmia?

a. Amiodarone

b. Verapamil

c. Quinidine

d. Propranolol

c. increased hepatic toxicity

Kava-kava and acetaminophen interaction may lead to;

a. increase bleeding time

b. autoimmune disease flare

c. increased hepatic toxicity

d. increase and prolong sympathomimetic effect

b. I and II

Herbal products that increase risk of bleeding include;

I. Ginkgo

II. Feverfew

III. Dong quai

a. I, II and III

b. I and II

c. II and III

d. I and III

d. Comfrey

---

• Licorice = high blood pressure risk

• Ma Huang = stimulant effects

• St. John’s wort = drug interactions

• Comfrey = Carcinogenic

This herb must be used in caution as it may be carcinogenic.

a. Licorice

b. Ma Huang

c. St. John’s wort

d. Comfrey

c. I and III

Asian and Siberian ginseng may be used to increase physical stamina. These herbs should be avoided by patients;

I. with hypertension

II. with autoimmune diseases

III. on warfarin therapy

a. I, II and III

b. I and II

c. I and III

d. I only

c. May interact with SSRI

---

St. John’s wort = herbal antidepressant that can interact with many drugs, especially SSRIs (can cause serotonin syndrome if combined)

Which of the following statements is correct regarding St. John’s wort?

a. It’s safety in pregnancy is unknown

b. It is not helpful in treating mild depression

c. May interact with SSRI

d. May interact with milk and cheese

b. garlic

---

• Garlic = reduce atherosclerosis risk

• Saw palmetto = used for prostate health

• Ginger = helps with digestion and nausea, may thin blood

• Valerian = used to help with sleep and anxiety

A patient, 32 years old has a family history of heart disease and would like to considered herbal supplement to reduce the risk of developing atherosclerosis as he aged. Which of the following could be beneficial to him?

a. saw palmetto

b. garlic

c. ginger

d. valerian

d. insulin

Garlic should be used with caution by diabetics since it may increase the release of:

a. serotonin

b. adrenaline

c. histamine

d. insulin

a. micturition difficulty

---

Saw palmetto is mainly used to help with urinary problems, especially those caused by benign prostatic hyperplasia (BPH), which leads to difficulty in urination (micturition difficulty).

Saw palmetto is indicated for the treatment of:

a. micturition difficulty

b. cirrhosis

c. fatigue

d. convalescence

d. I, II and III

For medications requiring administration at school or day care, pharmacists should also explore problems with;

I. Dosage formulation

II. Taste or texture aversion

III. Dosing frequency

a. I only

b. II only

c. III only

d. I, II and III

b. Dong quai or Female Ginseng

---

• Garlic = helps lower cholesterol and blood pressure

• Kava = liver damage, sedative effects

• Ma Huang = stimulant, can raise blood pressure and cause heart problems

Only Dong quai is linked with risks like MI, strokes, or seizures in this question.

This herb is considered unsafe since it may cause MI, strokes or seizures.

a. Garlic

b. Dong quai or Female Ginseng

c. Kava

d. Ma Huang

c. Milk thistle

---

Hepatotoxic herbs (can harm liver) = Kava, Germander, Liferoot

Not hepatotoxic = Milk thistle (actually helps protect liver)

Hepatotoxic herbs include all of the following EXCEPT:

a. Kava

b. Germander

c. Milk thistle

d. Liferoot

d. Echinacea or purple cone flower

---

• Echinacea (purple coneflower) = helps prevent colds and flu

• Feverfew = used for migraines, not colds

• Black Cohosh = used for menopause symptoms

• Ginkgo = helps with memory and circulation

The patient asks the pharmacist about a supplement that could prevent colds and flus during the winter months. Which of the following could be recommended?

a. Feverfew

b. Black Cohosh

c. Ginkgo

d. Echinacea or purple cone flower

d. Category X

The classification of drug according to the degree of their potential risk during pregnancy is contraindicated in women who are or may become pregnant.

a. Category A

b. Category B

c. Category C

d. Category X

a. Category A

Classification of drug according to the degree of their potential risk during pregnancy as showed no risk in controlled studies.

a. Category A

b. Category B

c. Category C

d. Category D

b. I and III

FDA Pregnancy Category D;

I. Studies show human fetal risk

II. Contraindicated in pregnancy

III. Potential benefit in pregnant women may outweigh risk

a. I, II and III

b. I and III

c. II and III

d. II only

a. A

Etretinate, a derivative of vitamin ____, is a potent teratogen in human and should be discontinued several months before pregnancy.

a. A

b. B

c. C

d. D

a. Warfarin

---

• Warfarin = most teratogenic especially 1st trimester

• Finasteride = causes male genital defects (mostly 2nd and 3rd trimester)

• Ethanol = causes fetal alcohol syndrome

• Phenytoin = causes fetal hydantoin syndrome

The most teratogenic agent in the first trimester of pregnancy, but can also cause malformation during the second and third trimester is;

a. Warfarin

b. Finasteride

c. Ethanol

d. Phenytoin

I and III

This drug increases the risk of neural tube defects.

I. Valproic acid

II. Phenytoin

III. Carbamazepine

a. I and II

b. II and III

c. I, II and III

d. III only

d. folic acid

---

Folic acid supplementation lowers the risk of neural tube defects in pregnancy.

Neural tube defects are lowered in women who are taking;

a. ascorbic acid

b. iron

c. riboflavin

d. folic acid

a. NSAIDs

---

NSAIDs taken by pregnant women, especially in the third trimester, can cause premature closure of the ductus arteriosus, leading to pulmonary hypertension in the newborn.

• NSAIDs = can close ductus arteriosus early

• Anticoagulants = cause bleeding risk, not ductus issues

• Anticonvulsants = cause birth defects, not ductus issues

• Antineoplastics = cause birth defects, not ductus issues

The use of these agents by pregnant women may cause ductus arteriosus to close prematurely and could result in pulmonary hypertension in newborn.

a. NSAIDs

b. anticoagulants

c. anticonvulsants

d. antineoplastics

d. Category X

Based on pregnancy risk, Tretinoin administered topically is classified as;

a. Category A

b. Category B

c. Category D

d. Category X

a. metoclopramide

---

• Methyldopa: Used to treat high blood pressure, especially in pregnancy

• Haloperidol: Antipsychotic medication for schizophrenia and psychosis

• Dicyclomine: Antispasmodic for irritable bowel syndrome (IBS)

• Metoclopramide is used to increase milk production.

This drug has been used therapeutically to enhance milk production.

a. metoclopramide

b. methyldopa

c. haloperidol

d. dicyclomine

b. I and III

FDA Pregnancy Category X drug include;

I. Rosuvastatin

II. PTU

III. Finasteride

a. I and II

b. I and III

c. II and III

d. I only

c. mottling of teeth

---

• Tetracycline: mottling of teeth in children

• Chloramphenicol/Penicillin: can cause anemia

• Lithium: linked to Ebstein anomaly (heart defect)

• Opioids/Sedatives: neonatal apnea (brief pauses in breathing in newborns)

Tetracycline should not be used in children because it can cause;

a. neonatal apnea

b. anemia

c. mottling of teeth

d. Ebstein anomaly

c. Hydantoins

Cleft lip and cleft palate are congenital abnormalities associated with the use these agents during pregnancy.

a. Alcohol

b. Cigarette smoking

c. Hydantoins

d. Lithium